Ticket for Outdoor Patient
| Ward No. 13 | U-PHC No. | Registration No. 01528 | Date 27/12/2018 |
| Token No | SM/20-21/9243 31/03/2021 | Serial | 015 |
| Patient Name | Mrs. GITA NANDI | Contact No | NOT GIVEN |
| Address | 92/A DEY STREET | Age | 55 Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||